Blood thinners after surgery: What to know to stay safe

A hospital stay is hard enough, but often the worries continue even after you are discharged. One reason is that many patients leave the hospital with a prescription for blood thinners, especially after surgery. This is generally a good thing—blood thinners serve a key purpose by preventing the formation of dangerous blood clots. 

But blood thinners also come with serious risks for bleeding. Understanding those risks and taking the right actions to protect yourself can make all the difference in keeping you healthy. It starts with these steps.

Step 1: Pay attention to options

While warfarin (brand name Coumadin) may be the most familiar blood thinner, recent research shows that new anticoagulant options may be more effective, come with a lower risk of uncontrollable bleeding, and are less likely to interact with food and other medicines—though they may cost more, too. So talk to your doctor about the pros and cons of various brands, such as Eliquis, Pradaxa, or Xarelto.

For any blood thinner, ask about the unique precautions you’ll have to take. For example, people taking warfarin need to have regular blood tests done to ensure the dosage amount is safe. And vitamin K-rich foods—such as tuna, leafy greens, broccoli, peas, pickles, and soybeans—can reduce warfarin’s effectiveness.

Step 2: Watch interactions

Don’t just resume your usual regimen of supplements, over-the-counter medicines, or eating habits: There are items in each of these categories that can interact with blood thinners, making them less effective or increasing the risk of bleeding. For example, taking a daily aspirin with a blood thinner increases the risk of internal bleeding in the digestive system.

As with any new medication, read all of the notes from your doctor and those that come with the prescription, and ask any questions you have while using it.

Step 3: Let “everyone” know 

In addition to telling your friends, family, and co-workers that you are taking a blood thinner, be sure to notify your family doctor and health care specialists, including your dentist, eye doctor, and pharmacist. Remember: Your pharmacy team can’t check for drug interactions if you don’t tell them what you were prescribed in the hospital. 

Step 4: Keep a medical ID card in your wallet

If your blood thinner prescription is only for a short duration, you may not feel the need for a medical ID bracelet, but at least put a note in your wallet that lists each medication you’re taking. Include the name (generic and brand names), what the dose is, when you started taking it, and when you take it each day. This is important because different types of blood thinners have different “antidotes”—or medicines that can help “reverse” bleeding, if necessary. The note should also list your doctors’ names and contact information, as well as your own (and your address). 

Step 5: Protect yourself from cuts and bruises

You may not normally think too much about the little nicks and cuts that you can get doing everyday activities, but while you are taking a blood thinner, it is important to keep those in mind—and avoid getting hurt in the first place. For example:

• Be extra careful with (or avoid) handling sharp objects like scissors, knives, and nail clippers. 
• Use waxed dental floss and a soft-bristle toothbrush, and don’t use toothpicks.
• Switch to an electric razor for shaving.
• If you’re getting a haircut, ask your stylist to be super careful. 
• Always wear well-fitting, non-skid shoes and socks—even indoors.
• Wear protective gear such as gloves and helmets, and protective eyewear for activities like yardwork or sports. Better yet: Switch to safer activities like walking and swimming for the time being.

Step 6: Be aware of the signs of bleeding

It’s important to know what signs and symptoms mean you should call the doctor or 911 immediately. According to the American Heart Association and the Agency for Healthcare Research and Quality, these include:

• Uncontrollable bleeding from the gums, nose, or a cut
• Coughing or spitting up anything red or brown
• Urine that is red or brown
• Bowel movements that are red or tar-like
• Heavier-than-normal menstrual bleeding
• Severe headache, stomachache, or other pain
• Unusual, unexplained, and/or frequent bruises or blood blisters
• Any accident, fall, or bump on the head—even if there is no visible bleeding
• Dizziness, faintness, or weakness

Note: Women should notify their doctor if they think they may be pregnant.